External links

War Stories, Martin Enserink, Science 15 March 2013: 1264–1268. In 2003, the world successfully fought off a new disease that could have become a global catastrophe. A decade after the SARS outbreak, how much safer are we?

SARS: Chronology of the Epidemic Martin Enserink, Science 15 March 2013: 1266–1271. In 2003, the world successfully fought off a new disease that could have become a global catastrophe. Here's what happened from the first case to the end of the epidemic.

Understanding the Enemy, Dennis Normile, Science 15 March 2013: 1269–1273. Research sparked by the SARS outbreak increased the understanding of emerging diseases, though much remains to be learned.

See also

The World Health Organization declared severe acute respiratory syndrome contained on 9 July 2003. In the year after, SARS made the occasional appearance. There were four cases spotted in China in December 2003 and January 2004. As well, three separate laboratory accidents resulted in infections; in one case, an ill lab worker spread the virus to several other people.[4][30] The precise coronavirus that caused SARS is gone or mostly contained within different BSL-4 laboratories for research much like Smallpox, but different coronaviruses remain circulating in the wild, like MERS, the Common Cold and gastroenteritis.

Containment

In late May 2003, studies from samples of wild animals sold as food in the local market in Guangdong, China, found the SARS coronavirus could be isolated from masked palm civets (Paguma sp.), but the animals did not always show clinical signs. The preliminary conclusion was the SARS virus crossed the xenographic barrier from palm civet to humans, and more than 10,000 masked palm civets were killed in Guangdong Province. Virus was also later found in raccoon dogs (Nyctereuteus sp.), ferret badgers (Melogale spp.), and domestic cats. In 2005, two studies identified a number of SARS-like coronaviruses in Chinese bats.[27][28] Phylogenetic analysis of these viruses indicated a high probability that SARS coronavirus originated in bats and spread to humans either directly or through animals held in Chinese markets. The bats did not show any visible signs of disease, but are the likely natural reservoirs of SARS-like coronaviruses. In late 2006, scientists from the Chinese Centre for Disease Control and Prevention of Hong Kong University and the Guangzhou Centre for Disease Control and Prevention established a genetic link between the SARS coronavirus appearing in civets and humans, bearing out claims that the disease had jumped across species.[29]

The CDC and Canada's National Microbiology Laboratory identified the SARS genome in April, 2003.[24][25] Scientists at Erasmus University in Rotterdam, the Netherlands demonstrated that the SARS coronavirus fulfilled Koch's postulates thereby confirming it as the causative agent. In the experiments, macaques infected with the virus developed the same symptoms as human SARS victims.[26]

Identification of virus

Another larger cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in its drainage system. Concerned citizens in Hong Kong worried that information was not reaching people quickly enough and created a website called sosick.org, which eventually forced the Hong Kong government to provide information related to SARS in a timely manner.

In Hong Kong, the first cohort of affected people were discharged from the hospital on 29 March 2003. The disease spread in Hong Kong from a mainland doctor who arrived in February and stayed at the ninth floor of the Metropole Hotel in Kowloon, infecting 16 of the hotel visitors. Those visitors traveled to Canada, Singapore, Taiwan, and Vietnam, spreading SARS to those locations.[23]

The epidemic reached the public spotlight in February 2003, when an American businessman traveling from China became afflicted with pneumonia-like symptoms while on a flight to Singapore. The plane stopped at Hanoi, Vietnam, where the victim died in The French Hospital of Hanoi. Several of the medical staff who treated him soon developed the same disease despite basic hospital procedures. Italian doctor Carlo Urbani identified the threat and communicated it to WHO and the Vietnamese government; he later succumbed to the disease.

Spread to other countries and regions

Many doctors and other medical staff in many nations heroically risked their lives treating patients and containing the infection before ways to prevent infection were known. Not all survived.[22]

In early April, after Jiang Yanyong pushed to report the danger to China,[19][20] there appeared to be a change in official policy when SARS began to receive a much greater prominence in the official media. Some have directly attributed this to the death of American James Earl Salisbury.[21] However, also in early April, accusations by Jiang Yanyong emerged regarding the undercounting of cases in Beijing military hospitals.[19][20] After intense pressure, Chinese officials allowed international officials to investigate the situation there. This revealed problems plaguing the aging mainland Chinese healthcare system, including increasing decentralization, red tape, and inadequate communication.

Subsequent to this, the WHO requested information from Chinese authorities on 5 and 11 December. Despite the successes of the network in previous outbreak of diseases, it was proven rather defective after receiving intelligence on the media reports from China several months after the outbreak of SARS. Along with the second alert, WHO released the name, definition, as well as an activation of a coordinated global outbreak response network that brought sensitive attention and containment procedures (Heymann, 2003). However, by then although the new definitions do give nations a guideline to contain SARS, over 500 deaths and an additional 2,000 cases had already occurred worldwide.[18]

The first clue of the outbreak appears to be 27 November 2002 when Canada's Arabic, Chinese, English, French, Russian, and Spanish translation, the system was limited to English or French in presenting this information. Thus, while the first reports of an unusual outbreak were in Chinese, an English report was not generated until 21 January 2003.[17][17][18]

(*) Figures for the People's Republic of China exclude the Special Administrative Regions (Macau SAR, Hong Kong SAR), which are reported separately by the WHO.

(**) Since 11 July 2003, 325 Taiwanese cases have been 'discarded'. Laboratory information was insufficient or incomplete for 135 discarded cases; 101 of these patients died.

Source:WHO.[15]

History

SARS was a relatively rare disease, with 8,273 cases as of 2003.[14]

Areas of the World Affected by SARS in 2002 – 2003

Epidemiology

There is no vaccine to date. Isolation and quarantine remain the most effective means to prevent the spread of SARS. In addition, handwashing, use of universal precautions, disinfection of surfaces for fomites, and use of a surgical mask are recommended. Avoid contact with bodily fluids. Continue with precautions for at least 10 days after the person's signs and symptoms have disappeared. Keep children home from school if they develop a fever or respiratory symptoms within 10 days of being exposed to someone with SARS. Wash personal items in hot, soapy water including the eating utensils and dishes, bedding and clothing of someone with SARS.[13] Annual influenza vaccinations and 5-year pneumococcal vaccinations may be beneficial; but vaccinations only reduce or weaken the severity of SARS infection.

Prevention

Several consequent reports from China on some recovered SARS patients showed severe long-time sequelae exist. The most typical diseases include, among other things, pulmonary fibrosis, osteoporosis, and femoral necrosis, which have led to the complete loss of working ability or even self-care ability of these cases. As a result, some of the post-SARS patients suffer from major depressive disorder.[12]

Prognosis

As of 2015, there is no cure or protective vaccine for SARS that is safe for use in humans.[8] The identification and development of novel vaccines and medicines to treat SARS is a priority for governments and public health agencies around the world. MassBiologics, a non-profit organization engaged in the discovery, development and manufacturing of biologic therapies, is cooperating with researchers at NIH and the CDC developed a monoclonal antibody therapy that demonstrated efficacy in animal models.[9][10][11]

Some of the more serious damage in SARS may be due to the body's own immune system reacting in what is known as cytokine storm.[7]

Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with complete barrier nursing precautions taken for any necessary contact with these patients.

Antibiotics are ineffective, as SARS is a viral disease. Treatment of SARS is largely supportive with antipyretics, supplemental oxygen and mechanical ventilation as needed.

Treatment

The chest X-ray (CXR) appearance of SARS is variable. There is no pathognomonic appearance of SARS, but is commonly felt to be abnormal with patchy infiltrates in any part of the lungs. The initial CXR may be clear.[6]

Contact (sexual or casual, including tattoos) with someone with a diagnosis of SARS within the last 10 days OR

Travel to any of the regions identified by the World Health Organization (WHO) as areas with recent local transmission of SARS (affected regions as of 10 May 2003 were parts of China, Hong Kong, Singapore and the town of Geraldton, Ontario, Canada).

Any of the symptoms, including a fever of 38 °C (100 °F) or higher, and

Either a history of:

SARS may be suspected in a patient who has:

A chest X-ray showing increased opacity in both lungs, indicative of pneumonia, in a patient with SARS

[4] It then was eradicated by January the following year.[3] Within weeks, SARS spread from Hong Kong to infect individuals in 37 countries in early 2003.[2]

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